Two more blood pressure medications recalled for ingredient that might cause cancer

Be careful out there. 

Two more blood pressure medications recalled for ingredient that might cause cancer

By David J. Neal
dneal@miamiherald.com

November 28, 2018 06:00 AM

Updated November 28, 2018 02:05 PM

The list of blood pressure drugs recalled because they have NDEA grew by two Tuesday when Teva Pharmaceuticals yanked all lots of Amlodipine/Valsartan and Amlodipine/Valsartan/Hydrochlorothiazide combination tablets.

Both have too much N-nitroso-diethylamine (NDEA) in its Valsartan, the active ingredient made by Mylan India. NDEA has been classified as a probable cancerous ingredient by the International Agency for Research on Cancer.
More NDEA than allowed prompted Mylan’s recall of 15 heart attack and blood pressure medications last week, as well as Sandoz’s recall of Losartan blood pressure meds on Nov. 8 and July’s slew of Valsartan blood pressure drug recalls.

As with previous recalls, the company-written, FDA-posted recall notice advises continuing to take the recalled drugs until the patient and a medical professional agree on another course of action.
“The risk of harm to a patient’s health may be higher if the treatment is stopped immediately without any comparable alternative treatment,” the notice states.

Specific lots in the article. 

Read more here: https://www.miamiherald.com/news/health-care/article222286590.html#storylink=cpy

Read more here: https://www.miamiherald.com/news/health-care/article222286590.html#storylink=cpy

Paleo diet linked to heart disease biomarker

So ask your doctor to translate this into diet protocols for all your needs. 

But I bet your stroke hospital is so fucking incompetent it doesn't even have ANY DIET PROTOCOL.
For stroke prevention; for dementia prevention; for cognitive improvement; for cholesterol reduction; for plaque removal; for Parkinsons prevention; for inflammation reduction; for blood pressure reduction. You can't be expected to figure this out on your own, your doctor is being paid for medical expertise. Demand that some expertise be delivered.   

 

Paleo diet linked to heart disease biomarker

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Nov 29 2018Reviewed by Kate Anderton, B.Sc.

More than twice the amount of a key biomarker linked closely to heart disease has been found in the blood of people on the paleo diet.
Researchers from Edith Cowan University have just completed the world’s first major study examining the impact of the paleo diet on gut bacteria.

Image Credit: MaraZe / Shutterstock

The controversial paleo (or ‘caveman’) diet advocates eating meat, vegetables, nuts and limited fruit, therefore excluding grains, legumes, dairy, salt, refined sugar and processed oils.
ECU researchers compared 44 people on the diet with 47 following a traditional Australian diet.
They measured the amount of trimethylamine-n-oxide (TMAO) in the participants’ blood. High levels of TMAO, an organic compound produced in the gut, are associated with an increased risk of cardiovascular disease.
Heart disease kills one Australian every 12 minutes.
Not good for the gut
Lead researcher Dr Angela Genoni from ECU’s School of Medical and Health Sciences said:
“Those who promote the paleo diet often cite it as beneficial for your gut health, but this research suggests there were adverse differences in those who followed the dietary pattern.”
She said the reason TMAO was so elevated in people on the paleo diet appeared to be due to the higher intake of red meats, but also because of the lack of whole grain intake.
“The paleo diet excludes all grains and we know that whole grains are a fantastic source of resistant starch, and many other fermentable fibres which are vital to the health of your gut microbiome,” Dr Genoni said.
“Because TMAO is produced in the gut, a lack of whole grains might change the populations of bacteria enough to enable higher production of this compound.
“Additionally, the paleo diet includes greater servings per day of red meat, which provides the precursor compounds to produce TMAO.”

Source:

http://www.ecu.edu.au/

The Post Ischaemic Stroke Cardiovascular Exercise Study: Protocol for a randomised controlled trial of fitness training for brain health

You'll have to ask your doctor for the results of this and if effective when the protocol will be instituted in the hospital. You do think that is part of your doctors' responsibility? That they keep up-to-date in their own field and institute such in their hospital?

The Post Ischaemic Stroke Cardiovascular Exercise Study: Protocol for a randomised controlled trial of fitness training for brain health

Show all authors

Liam Johnson, Emilio Werden, Chris Shirbin, ...

First Published July 10, 2018 Research Article

https://doi.org/10.1177/2396987318785845

Article information

Abstract

Introduction

Compared to healthy individuals, stroke patients have five times the rate of dementia diagnosis within three years. Aerobic exercise may induce neuroprotective mechanisms that help to preserve, and even increase, brain volume and cognition. We seek to determine whether aerobic fitness training helps to protect brain volume and cognitive function after stroke compared to an active, non-aerobic control.

Methods

In this Phase IIb, single blind, randomised controlled trial, 100 ischaemic stroke participants, recruited at two months post-stroke, will be randomly allocated to either the intervention (aerobic and strength exercise) or active control (stretching and balance training). Participants will attend one-hour, individualised exercise sessions, three days-per-week for eight weeks. Assessments at two months (baseline), four months (post-intervention), and one year (follow-up) post-stroke will measure brain volume, cognition, mood, cardiorespiratory fitness, physical activity, blood pressure and blood biomarkers.
Study outcome: Our primary outcome measure is hippocampal volume at four months after stroke. We hypothesise that participants who undertake the prescribed intervention will have preserved hippocampal volume at four months compared to the control group. We also hypothesise that this group will have preserved total brain volume and cognition, better mood, fitness, and higher levels of physical activity, than those receiving stretching and balance training.

Discussion

The promise of exercise training to prevent, or slow, the accelerated rates of brain atrophy and cognitive decline experienced by stroke survivors needs to be tested. Post Ischaemic Stroke Cardiovascular Exercise Study has the potential, if proven efficacious, to identify a new treatment that could be readily translated to the clinic.

RecoverNow: A patient perspective on the delivery of mobile tablet-based stroke rehabilitation in the acute care setting

Is this good enough for your hospital to acquire this? Or will they DO NOTHING like usual?

RecoverNow: A patient perspective on the delivery of mobile tablet-based stroke rehabilitation in the acute care setting 

Show all authors

Karen Mallet, Rany Shamloul, Michael Pugliese, ...

First Published July 18, 2018 Research Article

https://doi.org/10.1177/1747493018790031

Article information

Abstract

Background/aim

We previously reported the feasibility of RecoverNow (a mobile tablet-based post-stroke communication therapy in acute care). RecoverNow has since expanded to include fine motor and cognitive therapies. Our objectives were to gain a better understanding of patient experiences and recovery goals using mobile tablets.

Methods

Speech-language pathologists or occupational therapists identified patients with stroke and communication, fine motor, or cognitive/perceptual deficits. Patients were provided with iPads individually programmed with applications based on assessment results, and instructed to use it at least 1 h/day. At discharge, patients completed a 19-question quantitative and open-ended engagement survey addressing intervention timing, mobile device/apps, recovery goals, and therapy duration.

Results

Over a six-month period, we enrolled 33 participants (three did not complete the survey). Median time from stroke to initiation of tablet-based therapy was six days. Patients engaged in therapy on average 59.6 min/day and preferred communication and hand function therapies. Most patients (63.3%) agreed that therapy was commenced at a reasonable time, although half expressed an interest in starting sooner, 66.7% reported that using the device 1 h/day was enough, 64.3% would use it after discharge, and 60.7% would use it for eight weeks. Sixty-seven percent of patients expressed a need for family/friend/caregiver to help them use it.

Conclusion

Our results suggest that stroke patients are interested in mobile tablet-based therapy in acute care. Patients in the acute setting prefer to focus on communication and hand therapies, are willing to begin within days of their stroke and may require assistance with the tablets.

Stroke patients can’t ask for a second opinion: a multi-specialty response to The Joint Commission’s recent suspension of individual stroke surgeon training and volume standards

You'll have to hope your stroke hospital has enforced standards for stroke surgeons. Or you'll have to ask your surgeon for proof of experience and success.

Stroke patients can’t ask for a second opinion: a multi-specialty response to The Joint Commission’s recent suspension of individual stroke surgeon training and volume standards

1. Adam S Arthur1,
2. J Mocco2,
3. Italo Linfante3,
4. David Fiorella4,
5. M Shazam Hussain5,
6. Tudor G Jovin6,
7. Raul Nogueira7,
8. Clemens Schirmer8,
9. John D Barr9,
10. Phillip M Meyers10,
11. Reade De Leacy11,
12. Felipe C Albuquerque12

Author affiliations

http://dx.doi.org/10.1136/neurintsurg-2018-014536

Statistics from Altmetric.com

If you were considering surgery on your brain to stave off a devastating stroke, you might ask about the training of the surgeon. You might ask how many times they had done the procedure. Unfortunately, patients with emergent large vessel occlusion strokes (ELVO) often cannot ask these important questions. Even if they could, they lack the time to consider their options. They depend on the healthcare system to bring them to a surgeon who gives them the best chance.

On September 17 2018, The Joint Commission (TJC) announced the suspension of individual physician training and volume requirements for acute ischemic stroke thrombectomy at hospitals certified as Comprehensive Stroke Centers (CSC) and Thrombectomy-Capable Stroke Centers (TCC). TJC decided to remove its previously established requirement for both an individual thrombectomy volume minimum and for physician-specific certification to perform acute stroke thrombectomy. These requirements were established based on multiple discussions of TJC’s own technical advisory panel (TAP). No discussion was held with the TAP before the suspension of training and volume requirements for individual physicians.

Why have individual requirements?

Initial evidence to support these requirements can be found in the multi-specialty recommendations for training by the Committee for Advanced Subspecialty Training (CAST).1 These recommendations emphasize the importance of training and experience for achieving optimal outcomes. As essential elements, the CAST recommendations include: cognitive training in the clinical neurosciences; critical procedural neuroendovascular training; and annual performance of a minimum of thrombectomies and other neuroendovascular procedures. These recommendations are based on a large body of evidence published in peer-reviewed literature consistently demonstrating that standards of training and case volumes for both physician operators and treating medical centers significantly influence procedural outcomes and should be requirements to ensure high-quality care for patients.2–6 The physician volume requirement is further supported by the same 2016 Centers for Medicare and Medicaid Services (CMS) Physician Supplier and Provider Services (PSPS) files and Provider Utilization File (PUF) cited by TJC in their suspension of volume requirement justification. The cited median volume of 15 thrombectomies for the physician cohort with >10 thrombectomies does not take into account that Medicare represented only 59% of thrombectomy patients.7 Simply adjusting for this differential raises the median to 25 thrombectomies. Additionally, the cited data do not account for the 30% increase in CMS thrombectomy claims from 2016 to 2017 (2016=5905 versus 2017=7649). This would suggest the median total volume for those same physicians would approximate to 35 in 2017. While 2018 data are not yet available, it is hard to imagine that these thrombectomy numbers have declined. By suspending physician training and volume requirements, TJC has adopted a position that lacks evidentiary foundation and is detrimental to patients.

Thrombectomy is effective… when performed by high-volume physicians who have undergone advanced subspecialty training

Level 1A evidence gathered from 10 randomized, controlled clinical stroke trials has unequivocally proven thrombectomy superior to medical management for acute ischemic stroke secondary to large vessel occlusion.8–17 It is essential to realize that these studies required experienced neuroendovascular physicians with established neurovascular clinical expertise. Translation of the beneficial outcomes from such trials into community practice without specialized physicians cannot be assumed. The importance of specialty expertise and volume was so important to these trials that, shortly after the trials’ publications, many of the principal Investigators came together in 2015 to write an editorial emphasizing this critical aspect of their studies.18 In this editorial, the authors emphasized, ’These data strongly suggest that high-volume centers that frequently treat stroke patients achieve better outcomes than low-volume hospitals that care for stroke patients infrequently. The recently published trials all enrolled the vast majority of their patients at such centers. As a result, it is reasonable to assume that similar outcomes may not be obtained from lower volume, less specialized hospitals.’ They further state that, ‘neurointerventionalists with appropriate expertise… are… critical components’ to thrombectomy care, and that ‘inexperienced or low-volume stroke hospitals will potentially jeopardize patient care and could lead to worse outcomes.’ These authors, many of whom ran the definitive trials providing evidence for thrombectomy, then concluded, ‘To ensure attainment of trial results in actual practice, patients should receive treatment at facilities certified as having the resources, personnel, organization, and continuous quality improvement processes characteristic of trial centers.’ The concept that low-volume, non-credentialed practitioners can suffice to garner TCC or CSC certification is as unrealistic now as it was in 2015.

The assumption that the benefit of acute stroke thrombectomy performed by expert physicians persists for physicians who lack neuroscience, cognitive, and procedural training, or who are operating with low case volumes is flawed. Furthermore, this assumption is not substantiated by published evidence and, if applied for certification or credentialing purposes, almost certainly will result in substandard patient outcomes.

More at link. 

'Plateau' in progress on heart disease, stroke deaths

What the hell is your strategy to solve and reverse that problem in stroke? Hopefully it is to look at all the 30 day deaths and solve them. NOT by lazily putting out more prevention press releases. Damn it all, do the hard work to solve stroke. NOT just waiting for SOMEONE ELSE TO SOLVE THE PROBLEM?

1.  Describe the problem exactly. 
2.  Write an RFP to researchers to solve that problem.
3.  Fund them with foundation grants.
4.  Write stroke rehab protocols based on the research.
5.  Get the Nobel prize in medicine  

'Plateau' in progress on heart disease, stroke deaths

The rate of deaths from heart disease barely decreased last year while deaths from stroke increased slightly, and life expectancy continued to slip in the U.S., according to federal statistics released Thursday.
The annual report on mortality from the Centers for Disease Control and Prevention found that heart disease killed 647,457 people in 2017, more than any other cause. The rate was 165 deaths per 100,000 people, a slight drop from 165.5 the year before.
Deaths from stroke on the other hand, the fifth-leading cause, increased 0.8 percent between 2016 and 2017. There were 146,383 stroke deaths in 2017, or a rate of 37.6 per 100,000 people.
Last year, the CDC issued a report warning that a decades-long decrease in stroke death rates had "slowed, stalled, or in some cases, reversed in recent years."
"This plateau in our progress to reduce heart disease and stroke deaths is disappointing, and we know there is much work to still be done," said Dr. Ivor J. Benjamin, president of the American Heart Association. "As we continue to see more scientific evidence supporting links between cardiovascular disease risk factors and so many other conditions, we are expanding our work in new directions that could have a profound impact on multiple fronts of our lifesaving mission."
The AHA is investing millions into areas related to brain health, such as Alzheimer's disease, and diabetes, a major risk factor for heart disease, said Benjamin, director of the Cardiovascular Center at the Medical College of Wisconsin.(Not one thing mentioned here has any specific measurable responsibility to solve all the problems in stroke. You fucking lazy bastards.)
Research shows people living with diabetes are at least two times more likely to develop and die from cardiovascular disease. Numerous studies also have linked brain and heart health.
"The more we learn about the fundamental causes of all deaths, we see so many connections that come back to the same risk factors that lead to heart disease and stroke," Benjamin said.
The CDC report showed Alzheimer's disease is the No. 6 cause of death, just behind stroke, and diabetes ranks seventh. The data tracked a 2.4 percent rise in diabetes-related deaths, from 80,058 in 2016 to 83,564 in 2017. Alzheimer's disease deaths rose 2.3 percent, from 116,103 to 121,404.
Here are other highlights from the CDC's National Center for Health Statistics report:

• The 10 leading causes of death, in order, are heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, flu and pneumonia, kidney disease, and suicide.

• Life expectancy decreased by slightly more than a month, to 78.6 years in 2017, largely because of increases in mortality from unintentional injuries, suicide, diabetes, and flu and pneumonia. The life expectancy decline follows a trend in recent years, with rates continuing to drop slightly since the 2015 rate of 78.8 years. "Life expectancy gives us a snapshot of the nation's overall health," CDC director Dr. Robert R. Redfield said in a statement, "and these sobering statistics are a wake-up call that we are losing too many Americans, too early and too often, to conditions that are preventable."

• Overall, men fared worse than women when it came to life expectancy. For men, life expectancy dropped from 76.2 to 76.1 years in 2017, while life expectancy for women stayed the same at 81.1 years.

• Drug overdose deaths rose by 9.6 percent, with the majority listed as unintentional. The report said 70,237 Americans died from drug overdoses in 2017 – or 21.7 deaths per 100,000 people. Synthetic opioids, including fentanyl, were the biggest factor, the report said.

• Flu and pneumonia claimed 5.9 percent more people, rising from 51,537 deaths in 2016 to 55,672 in 2017.

• Suicide deaths increased by 3.7 percent, from 44,965 in 2016 to 47,173 in 2017. Suicide rates in the U.S. have increased since 1999 for both men and women, and rates in the most rural U.S. counties are nearly twice as high as rates in the country's most urban counties.

If you have questions or comments about this story, please email editor@heart.org.

• Commentary from Christina M. Shay, director of Impact and Health Metrics at the American Heart Association: "US Life Expectancy Drops for Third Year in a Row – What We Know and Don’t Know From the 2017 CDC Mortality Report"

Doing This Activity 1 Hour a Week Lowers Heart Attack/Stroke Risk by 40-70 Percent - Strength training

You'll need your doctor to set up the correct protocol. You can't do this on your own, way too dangerous, practicing medicine without a license. 

Doing This Activity 1 Hour a Week Lowers Heart Attack/Stroke Risk by 40-70 Percent - Strength training

Yanghui Liu; Duck-chul Lee; Yehua Li; Weicheng Zhu; Riquan Zhang; Xuemei Sui; Carl J. Lavie; Steven N. Blair

+ Author Information

Check Ovid for access

View on Journal Site

Abstract

PurposeResistance exercise (RE) can improve many cardiovascular disease (CVD) risk factors, but specific data on the effects on CVD events and mortality are lacking. We investigated the associations of RE with CVD and all-cause mortality, and further examined the mediation effect of body mass index between RE and CVD outcomes.
MethodsWe included 12,591 participants (mean age 47 years) who received at least two clinical examinations 1987-2006. RE was assessed by a self-reported medical history questionnaire.
ResultsDuring a mean follow-up of 5.4 and 10.5 years, 205 total CVD events (morbidity and mortality combined) and 276 all-cause deaths occurred, respectively. Compared with no RE, weekly RE frequencies of one, two, three times or total amount of 1-59 minutes were associated with approximately 40-70% decreased risk of total CVD events, independent of aerobic exercise (AE) (all p-values <0.05). However, there was no significant risk reduction for higher weekly RE of more than four times or ≥60 minutes. Similar results were observed for CVD morbidity and all-cause mortality. In the stratified analyses by AE, weekly RE of one time or 1-59 minutes was associated with lower risks of total CVD events and CVD morbidity regardless of meeting the AE guidelines. Our mediation analysis showed that RE was associated with the risk of total CVD events in two ways: RE had a direct U-shape association with CVD risk (p-value for quadratic trend <0.001) and RE indirectly lowered CVD risk by decreasing BMI.
ConclusionEven one time or less than one hour/week of RE, independent of AE, is associated with reduced risks of CVD and all-cause mortality. BMI mediates the association of RE with total CVD events.

Three kinds of corporate mediocrity - applied to stroke

Brilliant analysis from Seth Godin. Which way are our fucking failures of stroke associations doing it? And our stroke hospitals and doctors? And our boards of directors don't see this and fire the lot?

Three kinds of corporate mediocrity 

Uncaring mediocrity, in which employees have given up trying to make things better
Focused mediocrity, in which the organization is intentionally average
Accidental mediocrity, in which people don’t even realize that they’re not delivering excellence.
Uncaring mediocrity is the most common form, and it often accompanies scale. It’s the accidental outcome that comes from trying to emulate an organization that’s focused on its mediocrity.
The mechanization and industrialization of cottage industries (like hotels, restaurants and healthcare) has led to a convenient homogenization for many. It means you can travel around the world and find better than decent accommodations and safe food, all at a fair price.
But it also means that most of the people working in these entities are treated like interchangeable cogs. They have no say at all about how things are done (or at least feel that way) and so they’ve emotionally checked out. It’s easier that way.
The products and services revert to the mean, sucking the humanity out of not just the people who work there, but from the interactions the customers have as well.
If you have a lousy meal at a real restaurant, the owner could hear from you and, it’s likely, not only fix it, but get back to you. Have a lousy experience with a Host, a Taco Bell, or a JW Marriott, though, and the odds are that the individual who reads your review has never even visited the place you’re talking about, and certainly doesn’t care enough to do anything about it.
One of the promises of the worldwide behemoth corporation was that reliability and quality was assured. The downside is that the chances that an internal insurgent can make things better go down.
As we see so many organizations seek to emulate the scale, influence and profits of the Fortune 100, it’s worth remembering that uncaring mediocrity shouldn’t be a north star.
Focused mediocrity is different. It’s intentional. It’s the act of chasing the banal, so that the largest possible number of people will be satisfied enough not to complain. This is the sieve of deliverability and the sword of mass.
The third kind of mediocrity happens when someone is uninformed. When they’re too busy or too lazy to pay attention to the taste of those they seek to serve or they don’t care enough to deliver it with quality and humanity.
At least have the guts to be mediocre on purpose.

Stroke rehab unit in Sheffield officially opened by visiting MP

YOU need to ask very specifically what their goals are for stroke patients. 100% recovery is the ONLY GOAL. Anything less or excuses needs to be immediately shot down. Survivors can no longer be polite about what we want. We don't want 'care', we want results. GET THERE!

Stroke rehab unit in Sheffield officially opened by visiting MP

 Secretary of State for Health and Social Care, Matt Hancock MP, officially opened the new Stroke Pathway Assessment and Rehabilitation Centre at Norfolk Park in Sheffield. The Minister was joined by staff and patients at an official ribbon cutting ceremony to mark the opening of the centre, which ensures patients who are not able to be discharged straight home from hospital receive specialist rehabilitative support, 24 hours a day, at a critical point in their recovery. The new 30-bedded centre, which is run by Sheffield Teaching Hospitals NHS Foundation Trust, is the culmination of a three-year programme to further improve stroke services in the city. Matt Hancock said: “The integrated care I saw today in Sheffield was fantastic. Having this sort of rehabilitation facility in the community gives stroke survivors the best chance at recovery, and it was great to see first-hand the different ways staff are supporting patients, from tai chi to cooking skills. It’s the sort of thing we want to see lots more of in our NHS.” Interim chief executive for Sheffield Teaching Hospitals NHS Foundation Trust, Kirsten Major, said: “I am incredibly proud of what our team have achieved in bringing this new facility to Sheffield. This is the end of a three-year programme to further improve stroke services in the city, bringing together a range of healthcare professionals, including GPs, physiotherapists, dietitians, occupational therapists, speech and language therapists and rehabilitation nurses, to ensure stroke survivors get the right treatment at the right point in their recovery.”

Personalised Physical Exercise Program Reverses Functional Decline in Adults Aged Older Than 75 Years

But is this enough to also reverse your lost 5 cognitive years from your stroke? This is absolutely your doctors responsibility to give you a protocol on this. Incompetence on your doctors' part can't be tolerated. 

Personalised Physical Exercise Program Reverses Functional Decline in Adults Aged Older Than 75 Years

An individualised, multicomponent exercise program proved safe and effective to reverse the functional decline associated with acute hospitalisation in very elderly patients, according to a study published in JAMA Internal Medicine.
Nicolás Martínez-Velilla, MD, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain, and colleagues assessed the effects of an innovative multicomponent exercise intervention on the functional status of 370 very elderly patients undergoing acute-care hospitalisation.
Patients were randomised to an exercise or control (usual-care) intervention. The control group received usual-care hospital care, which included physical rehabilitation when needed. The in-hospital intervention included individualised moderate-intensity resistance, balance, and walking exercises (2 daily sessions).
The primary endpoint was change in functional capacity from baseline to hospital discharge, assessed with the Barthel Index of independence and the Short Physical Performance Battery (SPPB).
Secondary endpoints were changes in cognitive and mood status, quality of life, handgrip strength, incident delirium, length of stay, falls, transfer after discharge, readmission rate, and mortality at 3 months after discharge.
The exercise intervention program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 2.2 points on the Short Physical Performance Battery (SPPB) scale and 6.9 points on the Barthel Index over the usual-care group.
Hospitalisation led to an impairment in functional capacity (mean change from baseline to discharge in the Barthel Index of -5.0 points in the usual-care group, whereas the exercise intervention reversed this trend (1.9 points).
The intervention also improved the SPPB score (2.4 points vs 0.5 points in controls). Significant intervention benefits were also found at the cognitive level of 1.8 points over the usual-care group.
“Our study shows that intervention involving, innovative, personalised multicomponent physical exercise that includes moderate intensity endurance training over a very short period of time, has a significant benefit on routine care, and may help to reverse the functional and cognitive deterioration associated with the hospitalisation of the elderly,” said Dr. Martínez-Velilla.
Reference: http://dx.doi.org/10.1001/jamainternmed.2018.4869
SOURCE: Elhuyar Fundazioa

Study Finds Biases in Widely Used Dementia Identification Tests

And since your doctor should be testing for your dementia risk, you need to be concerned about this. I hit all the right categories; higher education, white, young, not in nursing home. When I went to a psychiatrist I analyzed the questions she was giving me, I would do the same for any dementia test. A doctor once gave me the Neuropsychological Assessment Battery®  Digits Forward/Digits Backward Test while in the hospital. He mentioned that I was the only patient he had that had ever gotten thru the whole test. I asked if that meant I was normal. He said no.

Study Finds Biases in Widely Used Dementia Identification Tests

Brief cognitive assessments used in primary care settings to identify whether people are likely to have dementia may often be wrong, according to a study published in Neurology.
The 3 tests examined in the study were the Mini-Mental State Examination, the Memory Impairment Screen, and Animal Naming.
“Our study found that all 3 tests often give incorrect results that may wrongly conclude that a person does or does not have dementia,” said David Llewellyn, PhD, University of Exeter Medical School, Exeter, United Kingdom. “Each test has a different pattern of biases, so people are more likely to be misclassified by one test than another depending on factors such as their age, education and ethnicity.”
For the study, 824 people in the United States with an average age of 82 years were given full dementia assessments that included a physical exam, genetic testing for the APOE gene, psychological testing, and comprehensive memory and thinking tests. The researchers divided participants into 2 groups based on the comprehensive dementia diagnosis. Of the participants, 35% had dementia and 65% did not.
Participants took each of the 3 quick tests and researchers found that 36% of participants were wrongly classified by at least 1 of the tests, but only 2% were misclassified by all 3 tests. Overall rates of misclassification by these tests individually ranged from 14% to 21%, including both false-positive and false-negative results.
Researchers also found that different tests had different biases. One test had an education bias, in that those with higher education were more likely to be misclassified as not having dementia and those with lower education were more likely to be misclassified as having dementia. Older age, having an ethnic background other than white, and living in a nursing home also led to misclassification. Across all tests, a lack of information on whether a family member or friend rated the participant’s memory to be poor resulted in an increased risk of misclassification.
“Failing to detect dementia can delay access to treatment and support, whereas false alarms lead to unnecessary investigations, causing pressure on health care systems,” said Dr. Llewellyn. “Identifying people with dementia in a timely fashion is important, particularly as new methods of treatment come on-stream. Our findings show that we desperately need more accurate and less biased ways of detecting dementia swiftly in clinic.”
A limitation of the study was that other brief cognitive assessments in clinical use were not examined.
Reference: http://cp.neurology.org/lookup/doi/10.1212/CPJ.0000000000000566
SOURCE: American Academy of Neurology

Butyrate, neuroepigenetics and the gut microbiome: Can a high fiber diet improve brain health?

If there is any hope that this could help your recovery your doctors should do everything in their power to create diet protocols on this. But that won't occur, you are once again completely on your own without any medical guidance. But then, I'm not medically trained so you can't listen to me.  

Butyrate, neuroepigenetics and the gut microbiome: Can a high fiber diet improve brain health?

Author links open overlay panelMegan W.Bourassa^abIshraqAlim^abScott J.Bultman^cRajiv R.Ratan^ab

https://doi.org/10.1016/j.neulet.2016.02.009Get rights and content

Under a Creative Commons license

open access

Highlights

•

Interest in how diet influences brain function via the gut microbiome is growing.

•

Butyrate can protect the brain and enhance plasticity in neurological disease models.

•

Gut microbiota produce butyrate by fermenting carbohydrates in a high fiber diet.

•

Hypothesis: A high fiber diet can elevate butyrate to prevent/treat brain disorders.

Abstract

As interest in the gut microbiome has grown in recent years, attention has turned to the impact of our diet on our brain. The benefits of a high fiber diet in the colon have been well documented in epidemiological studies, but its potential impact on the brain has largely been understudied. Here, we will review evidence that butyrate, a short-chain fatty acid (SCFA) produced by bacterial fermentation of fiber in the colon, can improve brain health. Butyrate has been extensively studied as a histone deacetylase (HDAC) inhibitor but also functions as a ligand for a subset of G protein-coupled receptors and as an energy metabolite. These diverse modes of action make it well suited for solving the wide array of imbalances frequently encountered in neurological disorders. In this review, we will integrate evidence from the disparate fields of gastroenterology and neuroscience to hypothesize that the metabolism of a high fiber diet in the gut can alter gene expression in the brain to prevent neurodegeneration and promote regeneration.

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Keywords

Gut-brain axis

Neuroepigenetics

Butyrate

High fiber diet

Gut microbiome

1. Introduction

The relationship between our gut microbiota and nervous system is a large part of the gut-brain axis that has attracted increasing interest in recent years. It is estimated that 90% of the cells in the human body are of microbial origin, and the vast majority of these microbiota are comprised of 15,000–36,000 species of commensal and symbiotic bacteria that reside within the lumen of the gut [1], [2]. A diverse microbial community is crucial for our health and disease prevention based on microbiome studies (i.e., metagenomic sequence analyses) and perturbed energy homeostasis that has been observed in germ free mice [3]. Although it is not yet clear how gut microbiota positively and negatively affect brain function, multiple mechanisms are likely to be involved. Gut bacteria, have a prodigious metabolic capacity and some microbe-derived metabolites enter the circulation and can cross the blood-brain barrier. There is growing evidence that these microbes produce neurotransmitters, such as GABA and serotonin, modulate the immune system, alter epigenetic markers and produce bioactive food components and energy metabolites [2], [4], [5]. Thus, dietary manipulation to achieve a symbiosis that can improve the health of the microbiome and our brains is an attractive idea currently under investigation.

In this review, we will focus on the short chain fatty acid (SCFA), butyrate, which is most commonly produced by bacteria in the colon, and its role as a potential therapeutic for neurological diseases. Butyrate is an attractive therapeutic molecule because of its wide array of biological functions, such as its ability to serve as a histone deacetylase (HDAC) inhibitor, an energy metabolite to produce ATP and a G protein-coupled receptor (GPCR) activator. Pharmacologically, butyrate has had a profoundly beneficial effect on brain disorders ranging from neurodegenerative diseases to psychological disorders. In this review, we will discuss how butyrate is made and the pharmacological effects of butyrate in neurological disorders. Finally, we will summarize the current evidence that high fiber, butyrate-producing diets are capable of improving the health of our brains.

Pages more at the link. 

Association Between Early Outpatient Visits and Readmissions After Ischemic Stroke

Go back to the drawing board and figure out exactly what will reduce readmissions. Early outpatient visits mean nothing. Was something done at those visits that reduced readmissions? Solve the damn problem, don't just guess at the answer. I would have been fired in no time if I did that lousy a job at determining root cause of programming problems. 

Association Between Early Outpatient Visits and Readmissions After Ischemic Stroke

Samuel W. Terman

,

Mathew J. Reeves

,

Lesli E. Skolarus

, and

James F. Burke

Originally published13 Apr 2018Circulation: Cardiovascular Quality and Outcomes. 2018;11:e004024

• Correction(s) for this article

Abstract

Background:

Reducing hospital readmission is an important goal to optimize poststroke care and reduce costs. Early outpatient follow-up may represent one important strategy to reduce readmissions. We examined the association between time to first outpatient contact and readmission to inform postdischarge transitions.

Methods and Results:

We performed a retrospective cohort study of all Medicare fee-for-service patients discharged home after an acute ischemic stroke in 2012 identified by the InternationalClassification of Diseases, Ninth Revision, Clinical Modification codes. Our primary predictor variable was whether patients had a primary care or neurology visit within 30 days of discharge. Our primary outcome variable was all-cause 30-day hospital readmission. We used separate multivariable Cox models with primary care and neurology visits specified as time-dependent covariates, adjusted for numerous patient- and systems-level factors. The cohort included 78 345 patients. Sixty-one percent and 16% of patients, respectively, had a primary care and neurology visit within 30 days of discharge. Visits occurred a median (interquartile range) 7 (4–13) and 15 (5–22) days after discharge for primary care and neurology, respectively. Thirty-day readmission occurred in 9.4% of patients. Readmissions occurred a median 14 (interquartile range, 7–21) days after discharge. Patients who had a primary care visit within 30 days of discharge had a slightly lower adjusted hazard of readmission than those who did not (hazard ratio, 0.98; 95% confidence interval, 0.97–0.98). The association was nearly identical for 30-day neurology visits (hazard ratio, 0.98; 95% confidence interval, 0.97–0.98).

Conclusions:

Thirty-day outpatient follow-up was associated with a small reduction in hospital readmission among elderly patients with stroke discharged home. Further work should assess how outpatient care may be improved to further reduce readmissions.

Ingatestone teenager who suffered a stroke at 13 has been awarded with a national courage award

Recovery should not require courage. Your doctor should have all the skills and stroke protocols that get you 100% recovered. Starting with stoppingthe 5 causes of the neuronal cascade of death in the first week.

Not getting you 100% recovered is failure on your doctor and stroke hospitals part.

 

Ingatestone teenager who suffered a stroke at 13 has been awarded with a national courage award

After the stroke Elizabeth Kiss was unable to even lift her head

By

Hannah Brown

• 15:54, 26 NOV 2018
• Updated16:06, 26 NOV 2018

Elizabeth Kiss was presented her award by Casaulty stars Cath Shipton and Chelsea Halfpenny

by Taboola

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A teenager from Ingatestone has been awarded with a national courage award for her determination to recover from a stroke that left her with both mental and physical disabilities.
Elizabeth Kiss was just 13 when she collapsed at her family home complaining of a severe headache.
After being rushed to hospital, scans revealed that she had a clot in her brain which had caused a stroke.
“The stroke came as a total shock to everyone, I was a normal healthy kid,” Elizabeth said.
“We never thought that I could have had a stroke so young.
“Even when I arrived at hospital I wasn’t originally treated for a stroke because they thought I was having a migraine.”
Doctors were initially reluctant to operate because of her young age, but Elizabeth’s condition started to deteriorate, so they performed emergency surgery to try and remove the clot.
Unfortunately the procedure was unsuccessful, but Elizabeth started to improve, enough so that they were able to move her out of intensive care.

"She couldn’t lift her head and she had to be hoisted in and out of bed"

Doctors told the family that it was unlikely the clot could cause another stroke and she was put on medication.
However as Elizabeth recovered the effects of the stroke became clear, it had left her paralysed, unable to sit up or roll over in bed.
Elizabeth’s mother, Danielle, described what it was like for her daughter in those early days.
“It was so tough for Elizabeth, she couldn’t lift her head and she had to be hoisted in and out of bed, but she just kept pushing herself all the time,” she said.

ESJ Comment: Secondary prevention of stroke

Obviously there are NO PROTOCOLS for these patients. You are just a guinea pig. 'Can be' and 80% is not good enough.  We don't want 'care', we want results.

ESJ Comment: Secondary prevention of stroke

Original research article: “Availability of secondary prevention services after stroke in Europe: An ESO/SAFE survey of national scientific societies and stroke experts” European Stroke Journal DOI: 10.1177/2396987318816136   https://journals.sagepub.com/doi/full/10.1177/2396987318816136

Secondary prevention of stroke: never too late

Comment by Linxin Li
Stroke is the second most common cause of death and the leading cause of long-term disability in Europe.¹ Recurrent stroke is associated with physical disability, cognitive decline, mood disturbances and poor quality of life. However, early recurrent stroke can be reduced in up to 80% of cases with the implementation of optimal secondary prevention of stroke.² Although all countries across Europe agree that appropriate secondary preventive measures are important, information is lacking regarding the provision of secondary prevention services in different countries.

Acute stroke care in Europe

Following the recent publication of the ESO/SAFE/ESMINT/EAN survey on provision of Acute Stroke Care across Europe,³ in this issue of the ESJ, the ESO-SAFE Secondary Prevention Survey Steering Group reported their results of a survey on the availability of secondary prevention services after stroke in Europe.
Methodology of this survey is similar to the previous survey on acute stroke care, where consensus responses were sought from panels of three experts in each country, coordinated by national stroke society chairs, or an ESO-nominated expert where there was no national society. National or local stroke registries were identified where possible and in the absence of such information, the coordinator and experts were asked to perform best estimates by consensus.
Of all 50 countries, data were available from 46 countries. 71% countries reported access to some registry data and 54% identified national strategies including secondary stroke prevention. Overall provision of secondary prevention varied between countries of different GDPs, with gaps in care prevalent particularly in lower income countries. Highlights of the results are listed below

• Acute assessment: more than 60% of patients with a TIA were assessed by stroke specialists in high income countries, whilst 4 countries in the lowest tertile of GDP assessed >60% of patients in general medical clinics, and 3 countries in the lower two tertiles still deferred assessment of >20% patients to primary care. Even in high income countries, less than one third of them had >60% of the patients assessed on the same day, one of which took more than one week to see most patients.
• Investigation and interventions: prolonged cardiac monitoring was routinely performed for AF screening in only half of the countries. Blood pressure monitoring is standardly deferred to primary care with only a third of countries offering out-of-office monitoring. Significant delays until carotid intervention remain common across all countries, especially in lower income countries. 5 lower income countries reported that >60% of patients are not operated within one month.
• Management of risk factors: The commonest follow-up method was primary care (51%) and only 10% of the countries offered specialist-led follow-up clinics for most patients. Combined lifestyle management programmes are commonly available only in half of the countries. In contrast, the majority of patients across all countries receive antiplatelet and antihypertensive treatment at initial assessment. Statins are however less commonly prescribed in lower income countries. Moreover excellent compliance to secondary prevention medication in >60% of patients is only achieved in less than 60% of countries.

The authors concluded that, “despite significant advances in secondary stroke prevention over the past decade, many gaps in the provision of routine, cost-effective, evidence-based interventions across Europe remain”. The gaps identified in this survey also echoed with the Action Plan for Stroke in Europe,⁴ which identified 4 targets for 2030 in the area of secondary prevention, including incorporating secondary prevention in national stroke plans, ensuring that at least 90% of the stroke population is seen by a stroke specialist, and ensuring access to key investigations as well as key preventative strategies.
So, for secondary prevention of stroke, there is still many to do but it is never too late!
The full paper can be found on the ESJ website.

References

1. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 2014; 383: 245–254.
2. Rothwell PM, Giles MF, Chandratheva A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 2007; 370: 1432–1442.
3. Aguiar de Sousa D, von Martial R, Abilleira S, et al. Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries. Eur Stroke J 2018; DOI: 10.1177/2396987318786023
4. Bo Norrving, Jon Barrick, Antoni Davalos, et al. Action Plan for Stroke in Europe 2018–2030. Eur Stroke J 2018; DOI: 10.1177/2396987318808719

Virtual reality experiences, embodiment, videogames and their dimensions in neurorehabilitation

So we can't conclude any efficacy of using virtual reality for stroke rehab yet. You are a guinea pig if you get this for therapy.

Virtual reality experiences, embodiment, videogames and their dimensions in neurorehabilitation

• Daniel Perez-MarcosEmail authorView ORCID ID profile

Journal of NeuroEngineering and Rehabilitation201815:113

https://doi.org/10.1186/s12984-018-0461-0

©  The Author(s). 2018

• Received: 11 June 2018
• Accepted: 12 November 2018
• Published: 26 November 2018

Abstract

Background

In the context of stroke rehabilitation, new training approaches mediated by virtual reality and videogames are usually discussed and evaluated together in reviews and meta-analyses. This represents a serious confounding factor that is leading to misleading, inconclusive outcomes in the interest of validating these new solutions.

Main body

Extending existing definitions of virtual reality, in this paper I put forward the concept of virtual reality experience (VRE), generated by virtual reality systems (VRS; i.e. a group of variable technologies employed to create a VRE). Then, I review the main components composing a VRE, and how they may purposely affect the mind and body of participants in the context of neurorehabilitation. In turn, VRS are not anymore exclusive from VREs but are currently used in videogames and other human-computer interaction applications in different domains. Often, these other applications receive the name of virtual reality applications as they use VRS. However, they do not necessarily create a VRE. I put emphasis on exposing fundamental similarities and differences between VREs and videogames for neurorehabilitation. I also recommend describing and evaluating the specific features encompassing the intervention rather than evaluating virtual reality or videogames as a whole.

Conclusion

This disambiguation between VREs, VRS and videogames should help reduce confusion in the field. This is important for databases searches when looking for specific studies or building metareviews that aim at evaluating the efficacy of technology-mediated interventions.